Manila Bulletin

Harm by poi­son

- DR. JOSE PU­JALTE JR. Health · Athens · National Institutes of Health · Institutos Nacionales de Salud

“My heart aches, and a drowsy numb­ness pains my sense, as though of hem­lock I had drunk,” — John Keats (1795-1821), English Ro­man­tic poet, “Ode to a Nightin­gale” (1819)

John Keats would have known that hem­lock was both a drug and a poi­son for he was both a sur­geon and a poet. In fact, I want to think that he had Socrates in mind. Dy­ing by hem­lock was the great philoso­pher’s pun­ish­ment for “cor­rupt­ing the minds” of Athe­nian youth. This brings us to poi­son­ing, in­gested will­fully or by ac­ci­dent, the ef­fects of which are myr­iad.

Def­i­ni­tion. Poi­son­ing is de ned as “the harm­ful ef­fect that oc­curs when a toxic sub­stance is swal­lowed, is in­haled, or comes in con­tact with the skin, eyes, or mu­cous mem­branes, such as those of the mouth or nose,” (Merck Man­ual). This means that al­most any sub­stance taken in­cor­rectly or in ex­cess can be­come toxic. Ex­am­ples are over­the-counter drugs (parac­eta­mol, ac­etaminophe­n) or pre­scrip­tion drugs (ben­zo­di­azepines, heart med­i­ca­tions, etc.), and of course il­le­gal drugs, car­bon monox­ide in ve­hi­cle ex­hausts, house­hold prod­ucts like de­ter­gents and fur­ni­ture pol­ish, pes­ti­cides, and me­tals like lead and mer­cury.

First Aid.

The first rule for the first aider is NOT to get poi­soned him­self. The US Na­tional In­sti­tutes of Health web­site tells us what to do in cases of swal­lowed poi­son: For poi­son­ing by swal­low­ing: “Check and mon­i­tor the per­son’s air­way, breath­ing, and pulse. If nec­es­sary, be­gin res­cue breath­ing and CPR. Try to make sure that the per­son has in­deed been poi­soned. It may be hard to tell. Some signs in­clude chem­i­cal-smelling breath, burns around the mouth, dif­fi­culty breath­ing, vomit­ing, or un­usual odors on the per­son. If pos­si­ble, iden­tify the poi­son. Do NOT make a per­son throw up un­less told to do so by poi­son­con­trol or a health-care pro­fes­sional. If the per­son vom­its, clear the per­son’s air­way. Wrap a cloth around your ngers be­fore clean­ing out the mouth and throat. If the per­son has been sick from a plant part, save the vomit. It may help ex­perts iden­tify what medicine can be used to help re­verse the poi­son­ing. Keep the per­son com­fort­able. The per­son should be rolled onto the left side, and re­main there while get­ting or wait­ing for med­i­cal help. If the poi­son has spilled on the per­son’s clothes, re­move the cloth­ing and ush the skin with wa­ter.”

For in­haled poi­son­ing: “Call for emer­gency help. Never at­tempt to res­cue a per­son with­out no­ti­fy­ing oth­ers rst. If it is safe to do so, res­cue the per­son from the dan­ger of the gas, fumes, or smoke. Open win­dows and doors to re­move the fumes. Take sev­eral deep breaths of fresh air, and then hold your breath as you go in. Hold a wet cloth over your nose and mouth. Do not light a match or use a lighter be­cause some gases can catch

re. Af­ter res­cu­ing the per­son from dan­ger, check and mon­i­tor the per­son’s air­way, breath­ing, and pulse. If nec­es­sary, be­gin res­cue breath­ing and CPR. If the per­son vom­its, clear the per­son’s air­way. Wrap a cloth around your ngers be­fore clean­ing out the mouth and throat. Even if the per­son seems per­fectly ne, get med­i­cal help.”

I sup­pose that there’s some­thing both ro­man­tic and sel sh about poi­son­ing. It’s the stuff of tragic nov­els and te­len­ov­e­las. But as an in­tern at PGH’s Ad­mit­ting Sec­tion, I’ve seen and treated poi­son­ing cases. All that foam­ing in the mouth and vom­i­tus, shak­ing and moan­ing (and not in a good way), and if the sphinc­ters re­lax, urine and fe­ces all over. Not a pretty sight.

John Keats prob­a­bly wanted to poi­son him­self too in his long, los­ing bat­tle with tu­ber­cu­lo­sis. He kept ask­ing for lau­danum (cin­na­mon

avored 10% opium, 90% al­co­hol) to ease the pain of his bloody coughs. Drug ad­dic­tion is noth­ing but long­drawn poi­son­ing. I guess we all have our own poi­sons.

Dr. Pu­jalte is an ortho­pe­dic sur­geon. e-mail jspu­jalte@ya­hoo.com

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